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Oncology & Hematology Coding Alert

Reader Question:

Two Physicians

Published on Fri Dec 21, 2012

Question: When can two different physicians (in the same practice) bill for an inpatient visit on the same day?

Maryland Subscriber

Answer: Reimbursement is made only once per day on a subsequent hospital visit per practice. A patient is considered part of both physicians within the same practice and specialty. The exception is if the second doctor was required to see the patient due to a complication, worsening condition or new problem. In this case, bill the appropriate E/M code with modifier -25 (significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to indicate that the second visit was separate and identifiable from the first. Two different ICD-9 codes would also be needed to prove medical necessity.

For example, if a patient comes in for a follow-up visit [...]
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